DNR Orders Explained: What They Mean and How to Get One

A do-not-resuscitate (DNR) order is a medical order, written by a health care provider, that tells medical staff not to do CPR if your heart stops beating or you stop breathing. It applies to CPR only, so you still get pain relief, medicines and other care. To get one, talk with your provider. They record it in your chart if you are in a hospital and can explain how to get a wallet card, bracelet or state form for use at home.

What does a DNR order cover?

CPR (cardiopulmonary resuscitation) is the treatment you receive when your heart or breathing stops. MedlinePlus says it may include pressing on the chest and mouth-to-mouth breathing, an electric shock to restart the heart, breathing tubes to open the airway and give oxygen, and medicines.

A DNR order tells providers not to do these things. MedlinePlus is clear on its limits: it is specific to CPR and doesn't have instructions for other treatments, such as pain medicine, other medicines or nutrition. A person with a DNR order still receives treatment for everything else.

If you do want CPR, you don't have to do anything. Hospital staff will try to resuscitate any patient whose heart or breathing stops unless there is an order saying otherwise, according to the American Academy of Family Physicians.

How is a DNR different from an advance directive, living will or POLST?

These documents are often mixed up. They work together but do different jobs.

A POLST is meant for people who are seriously ill or have advanced frailty, according to the National POLST Collaborative. Because it is a medical order, it travels with you between a hospital, a nursing home, your home and hospice. A POLST can include a DNR choice, but it also covers other treatments such as feeding tubes and mechanical ventilation. If you are healthy, an advance directive is the right document. Our guide to making an advance healthcare directive goes through it step by step, and advance directive vs living will explains the main types.

MedlinePlus recommends that you include your wishes about CPR in your advance directive and tell your health care agent and family about your decision.

Who can have a DNR order, and how do you decide?

A DNR order is your choice. MedlinePlus says that if you are near the end of your life or have an illness that will not improve, you can choose whether you want CPR. The provider writes the order only after discussing it with you if possible, or with your health care proxy or family if you can't take part.

There is no hard and fast rule about what to choose. MedlinePlus suggests you think about it while you can decide for yourself, learn about your medical condition and what to expect, and talk to your provider about the pros and cons of CPR.

It helps to know that CPR doesn't always work. The CDC says more than 356,000 people have an out-of-hospital cardiac arrest in the US each year, and about 60% to 80% of them die before reaching the hospital. The American Heart Association reports that, in 2021 US data, 9.1% of adults treated by EMS for a non-traumatic out-of-hospital cardiac arrest survived to hospital discharge. These are population figures. How CPR is likely to work for you depends on your age, health and the cause of the arrest, which is exactly what your provider can talk through with you.

How to get a DNR order, step by step

1. Talk with your provider. Say you don't want CPR. Ask about your condition and what to expect. MedlinePlus says your provider must follow your wishes or may transfer your care to a provider who will.
2. Have the order written. In a hospital, your provider writes the DNR order in your medical record. Your provider can also fill out the form for you.
3. Get something that works outside the hospital. MedlinePlus says your provider can tell you how to get a wallet card, bracelet or other DNR document to have at home or in non-hospital settings, so emergency medical personnel can understand your status. It adds that standard forms may be available from your state's Department of Health. States have different forms and rules, so use the one your state recognizes.
4. Tell the people who need to know. That includes your health care agent, family and caregivers. If they don't know, they may not understand why responders aren't doing CPR.
5. Write it into your advance directive. That keeps your wishes consistent across documents.

If you are seriously ill, ask whether a POLST is also appropriate. It covers more decisions than a DNR order and is built to travel with you.

Will emergency responders follow it at home?

Only if they can see it. CaringInfo says emergency medical technicians can honor DNR orders and POLST forms when shown them, but can't act on an advance directive, a living will or a medical power of attorney. Without one of those orders, once they are called they must do what is necessary to stabilize a person for transfer to a hospital.

That is why the document needs to be easy to find. A DNR kept in a drawer, or only in a lawyer's file, doesn't help in the first minutes of an emergency. Ask your provider or local emergency medical services how your state expects the form or bracelet to be kept, and make sure everyone in the home knows where it is.

If you travel or move, check the rules for the state you are in. The National Cancer Institute warns that a living will or health care power of attorney accepted in one state may not be accepted in another, and DNR forms are also set by each state.

Can your family overrule a DNR?

If you can no longer decide for yourself, MedlinePlus explains who can act:

• If your provider already wrote a DNR order at your request, your family may not override it.
• If you named a health care agent, that person or a legal guardian can agree to a DNR order for you.
• If you named no one, a family member can in some circumstances agree to a DNR order for you, but only while you can't make your own medical decisions.

Can you change or cancel a DNR order?

Yes, whenever you like. MedlinePlus says that with a DNR order you always have the right to change your mind and ask for CPR. Tell your provider or health care team right away, tell your family and caregivers, and destroy any documents that include the DNR order. Take off a DNR bracelet and remove the wallet card too.

DNR, ventilators and breathing tubes

A DNR order is about CPR, and breathing support is a separate question. Intubation, according to MedlinePlus, is placing a tube into the windpipe, which can then be connected to a mechanical ventilator. You might feel differently about CPR than about a ventilator, so each one needs its own answer.

Treatments such as ventilation and tube feeding belong in your advance directive, and if you are seriously ill, in a POLST. Ask your provider how your state's forms handle breathing tubes. MedlinePlus notes that a DNR order may be part of a hospice care plan. See hospice care explained and palliative care vs hospice for how those types of care work.

What to do next

1. If you are thinking about a DNR, book a conversation with your provider about your health and what CPR would involve.
2. If you decide on one, ask for the order and for the right out-of-hospital form, card or bracelet for your state.
3. Tell your health care agent and family, and give copies to anyone who provides your care.
4. Add your wishes to an advance healthcare directive, and review them whenever your health changes.
5. Keep the rest of your plan in one place with the end-of-life planning checklist.